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Renal function is mostly preserved in patients with systemic sclerosis.

A Scheja¹, I Bartosik, D M Wuttge

¹Department of Rheumatology, University Hospital, Lund, Sweden. Agneta.scheja@med.lu.se

Scandinavian Journal of Rheumatology

|February 14, 2009

Summary

A minority of patients with systemic sclerosis (SSc) experience decreased kidney function beyond scleroderma renal crisis (SRC). This renal dysfunction is often linked to hypertension and cardiac issues, suggesting pre-renal causes.

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Area of Science:

Nephrology
Rheumatology
Internal Medicine

Background:

Chronic renal disease is not well-documented in systemic sclerosis (SSc) outside of scleroderma renal crisis (SRC).
Understanding non-SRC renal dysfunction in SSc is crucial for patient management.

Purpose of the Study:

To investigate the occurrence of decreased glomerular filtration rate (GFR) in a large systemic sclerosis (SSc) cohort.
To determine if decreased GFR in SSc is related to the disease itself or other underlying causes.

Main Methods:

GFR was measured annually in 461 SSc patients (1983-2004) using 51Cr-EDTA or iohexol clearance.
Decreased GFR was defined as <70% of age-adjusted values; SRC patients were excluded.
Patients were classified by SSc subtype: 356 limited cutaneous (lcSSc) and 105 diffuse cutaneous (dcSSc).

Main Results:

At follow-up (median 7.7 years), 11% of lcSSc and 8.6% of dcSSc patients had decreased GFR (excluding SRC).
Among 48 SSc patients with decreased GFR, 60% had hypertension and 52% had cardiac involvement.
Renal biopsy revealed nephropathies in 19% of these patients; 11/15 showed no GFR progression over 4 years.

Conclusions:

A minority of systemic sclerosis patients develop renal dysfunction unrelated to scleroderma renal crisis.
Decreased GFR in SSc is associated with hypertension and cardiac involvement, suggesting potential pre-renal etiologies.
Further investigation into the multifactorial causes of renal dysfunction in SSc is warranted.